Accuracy and clinical feasibility of 3D‑myocardial thickness map measured by cardiac computed tomogram

Background@#Although myocardial thickness is an important variable for therapeutic catheter ablation of cardiac arrhythmias, quantification of wall thickness has been overlooked. We developed a software (AMBER) that measures 3D-myocardial thickness using a cardiac computed tomogram (CT) image, verified its accuracy, and tested its clinical feasibility. @*Methods@#We generated 3D-thickness maps by calculating wall thickness (WT) from the CT images of 120 patients’ hearts and a 3D-phantom model (PhM). The initial vector field of the Laplace equation was oriented to calculate WT with the field lines derived from the 3D mesh. We demonstrate the robustness of the Laplace WT algorithm by comparing with the real thickness of 3D-PhM, echocardiographically measured left ventricular (LV) WT, and regional left atrial (LA) WT reported from previous studies. We conducted a pilot case of catheter ablation for atrial fibrillation (AF) utilizing real-time LAWT map-guided radiofrequency (RF) energy titration. @*Results@#AMBER 3D-WT had excellent correlations with the real thickness of the PhM (R = 0.968, p < 0.001) and echocardiographically measured LVWT in 10 patients (R = 0.656, p = 0.007). AMBER 3D-LAWT (n = 120) showed a relatively good match with 12 previously reported regional LAWT. We successfully conducted pilot AF ablation utilizing AMBER 3D-LAWT map-guided real-time RF energy titration. @*Conclusion@#We developed and verified an AMBER 3D-cardiac thickness map measured by cardiac CT images for LAWT and LVWT, and tested its feasibility for RF energy titration during clinical catheter ablation.

History and Future of the Korean Medical Education System / 의학교육논단

Western medicine was first introduced to Korea by Christian missionaries and then by the Japanese in the late 19th century without its historical, philosophical, cultural, social, political, and economic values being communicated. Specifically, during the Japanese colonial era, only ideologically ‘degenerated’ medicine was taught to Koreans and the main orthodox stream of medicine was inaccessible. Hence, Korean medical education not only focuses on basic and clinical medicine, but also inherited hierarchical discrimination and structural violence. After Korea's liberation from Japan and the Korean war, the Korean medical education system was predominantly influenced by Americans and the Western medical education system was adopted by Korea beginning in the 1980s. During this time, ethical problems arose in Korean medical society and highlighted a need for medical humanities education to address them. For Korean medical students who are notably lacking humanistic and social culture, medical humanities education should be emphasized in the curriculum. In the Fourth Industrial Revolution, human physicians may only be distinguishable from robot physicians by ethical consciousness; consequentially, the Korean government should invest more of its public funds to develop and establish a medical humanities program in medical colleges. Such an improved medical education system in Korea is expected to foster talented physicians who are also respectable people.

Origin and precondition of medical self-regulation: State philosophy and medical professionalism in France

In order to ensure the rights of medical self-regulation, what precondition should be fulfilled by the Korean Medical Association (KMA) or any other independent medical association or organization? Regulatory authority is defined as an exercise of legal power by the State for the rights and interests of the people. Thus, if Korean physicians seek to regulate themselves, on the one hand, the KMA or any other independent medical association or organization should achieve delegation from the State, and on the other, Korean medical professionalism should fully reflect the State philosophy. This paper aims to examine the origin and precondition of medical self-regulation in French State philosophy and French medical professionalism. For this purpose, the following topics are covered: (1) Who was involved in the establishment of the French State philosophy and what was the role of French physicians? (2) By whom and how was French State philosophy introduced in American State philosophy? (3) What medical ideas and values are included in the Declaration of Human and Civic Rights of 1789? (4) How is French State philosophy emblematized by three key values-freedom, equality, and fraternity-incorporated in French medical professionalism? Dealing with these topics, this paper claims, on the basis of French history and philosophy, that the most important precondition of medical self-regulation is for medical professionalism to sufficiently reflect the State philosophy, and consequently the KMA or any other independent medical association or organization representing Korean physicians should willingly be involved in shaping the Korean State philosophy.

Origin and precondition of medical self-regulation: State philosophy and medical professionalism in France

In order to ensure the rights of medical self-regulation, what precondition should be fulfilled by the Korean Medical Association (KMA) or any other independent medical association or organization? Regulatory authority is defined as an exercise of legal power by the State for the rights and interests of the people. Thus, if Korean physicians seek to regulate themselves, on the one hand, the KMA or any other independent medical association or organization should achieve delegation from the State, and on the other, Korean medical professionalism should fully reflect the State philosophy. This paper aims to examine the origin and precondition of medical self-regulation in French State philosophy and French medical professionalism. For this purpose, the following topics are covered: (1) Who was involved in the establishment of the French State philosophy and what was the role of French physicians? (2) By whom and how was French State philosophy introduced in American State philosophy? (3) What medical ideas and values are included in the Declaration of Human and Civic Rights of 1789? (4) How is French State philosophy emblematized by three key values-freedom, equality, and fraternity-incorporated in French medical professionalism? Dealing with these topics, this paper claims, on the basis of French history and philosophy, that the most important precondition of medical self-regulation is for medical professionalism to sufficiently reflect the State philosophy, and consequently the KMA or any other independent medical association or organization representing Korean physicians should willingly be involved in shaping the Korean State philosophy.

Historico-philosophical consideration on the social role of French doctor: medical anthropology of Pierre-Jean-Georges Cabanis (1757-1808) and the French code of medical deontology

Doctor's task cannot be limited to medical practice and research. As a citizen of society, and above all as a professional, doctors should not evade their social responsibilities. This idea was systematically developed and widely diffused throughout Europe by Pierre-Jean-Georges Cabanis (1757-1808). He was not only a doctor, but also a philosopher and a politician who lived at the time of the French Revolution. His philosophy on the nature of medicine and the social role of the doctor is conceptualized in his idea of medical anthropology (science de l'homme, anthropologie). In order to understand why the social role of the doctor was particularly emphasized in and around France, Cabanis' medical anthropology should be analyzed in depth. His medical anthropology is composed of three major domains: physiology, ethics, and analysis of ideologies. The following ideas of his medical anthropology can be identified in the current articles of the French code of medical deontology. 1) Health and disease being a social problem, a social solution should be sought (1.6, 1.7, 1.10, 2.37, 2.44, 2.50); 2) Medical practice is in principle not a commercial service for profit, but rather a public service supported by the government's power (1.12, 1.19, 1.21, 2.55, 3.57, 3.67); 3) Doctors should maintain their professional autonomy by establishing and observing the principles of self-regulation (1.1, 1.5, 1.31, 2.50, 5.109, 5.110). Referring to the historical experience of French doctors, the Korean medical community should also enter into a broad and fundamental reflection on the nature of medicine and the social role of the doctor.

Korean doctors' perception on doctor's social competency: based on a survey on doctors

Medicine is the practice that occurs in the context of the society. It requires interaction with individual patients, fellow doctors and other health care professionals, health care officials, public, institution, and the society as a whole. To date, medical practice in Korea has largely been concentrated on applying biomedical knowledge and skill to a patient. We defines 'social competency' as 'competency for medicine as a social institution.' This survey aims to grasp the current situation of Korean doctors' perception on social competency, in terms of necessity, satisfaction, learning experience, and possible intervention. Respondents generally recognized the necessity of social competencies but were not satisfied with their demonstration of those competencies. Competencies for 'understanding on law and institution' and 'communication' were perceived highly necessary. General satisfaction and each satisfaction rate on individual competencies were all below 'neutral,' showing their dissatisfaction. Especially, doctors assess their fellow doctors' competencies for 'understanding on law and institution' and 'understanding on human being and society' at the lowest level. The mismatch between perceived necessity and satisfaction shows the legitimate ground for educational intervention. The proportions of respondents who have learned on each domain of social competency were all below 70%. Learning experience on self-management and leadership was the least. Among possible remedy for low social competency, respondents perceived 'improvement on national health insurance' and 'improvement on resident training program' as the most urgently needed. The data from this preliminary survey can be utilized for educational and institutional intervention in the future.

The Vitalism of Paul-Joseph Barthez (1734~1806) / 의사학

In The Logic of Life (1970), Francois Jacob (1920~ ), Nobel Prize laureate in Physiology or Medicine (1965), proclaimed the end of vitalism based on the concept of life. More than two decades before this capital sentence condemning vitalism was pronounced, Georges Canguilhem (1904~1995), a French philosopher of medicine, already acknowledged that eighteenth-century vitalism was scientifically retrograde and politically reactionary or counter-revolutionary insofar as it was rooted in the animism of Georg Ernst Stahl (1660~1734). The negative preconception of the term 'vitalism' came to be established as an orthodox view, since Claude Bernard (1813~1878) unfairly criticized contemporary vitalism in order to propagate his idea of experimental medicine. An eminent evolutionary biologist like Ernst Mayr (1904~2005) still defended similar views in This is Biology (1997), arguing that if vitalists were decisive and convincing in their rejection of the Cartesian model (negative heuristics), however they were equally indecisive and unconvincing in their own explanatory endeavors (positive heuristics). Historically speaking, vitalists came to the forefront for their outstanding criticism of Cartesian mechanism and physicochemical reductionism, while their innovative concepts and theories were underestimated and received much less attention. Is it true that vitalism was merely a pseudo-science, representing a kind of romanticism or mysticism in biomedical science? Did vitalists lack any positive heuristics in their biomedical research? Above all, what was actually the so.called 'vitalism'? This paper aims to reveal the positive heuristics of vitalism defined by Paul.Joseph Barthez (1734~1806) who was the founder of the vitalist school of Montpellier. To this end, his work and idea are introduced with regard to the vying doctrines in physiology and medicine. At the moment when he taught at the medical school of Montpellier, his colleagues advocated the mechanism of Rene Descartes (1596~1650), the iatromechanism of Herman Boerhaave (1668~1738), the iatrochemistry of Jan Baptist van Helmont (1579~1644), the animism of Stahl, and the organicism of Theophile de Bordeu (1722~1776). On the contrary, Barthez devoted himself to synthesize diverse doctrines and his vitalism consequently illustrated an eclectic character. Always taking a skeptical standpoint regarding the capacity of biomedical science, he defined his famous concept of 'vital principle (principe vital)' as the 'x (unknown variable)' of physiology. He argued that the hypothetical concept of vital principle referred to the 'experimental cause (cause experimentale)' verifiable by positive science. Thus, the vital principle was not presupposed as an a priori regulative principle. It was an a posteriori heuristic principle resulting from several experiments. The 'positivist hypothetism' of Barthez demonstrates not only pragmatism but also positivism in his scientific terminology. Furthermore, Barthez established a guideline for clinical practice according to his own methodological principles. It can be characterized as a 'humanist pragmatism' for the reason that all sort of treatments were permitted as far as they were beneficial to the patient. Theoretical incoherence or incommensurability among different treatments did not matter to Barthez. His practical strategy for clinical medicine consisted of three principles: namely, the natural, analytic, and empirical method. This formulation is indebted to the 'analytic method (methode analytique)' of the French empiricist philosopher Etienne Bonnot de Condillac (1714~1780). In conclusion, the eighteenth.century French vitalism conceived by Barthez pursued pragmatism in general, positivism in methodology, and humanism in clinics.

Atopy Patch Tests for Atopic Dermatitis Patients according to the Concentration and Vehicle for the Cockroach Antigen / 대한피부과학회지

BACKGROUND:Recent studies have attempted to document the correlation of an atopy patch test (APT) and a skin prick test. The results have suggested a possible role of delayed allergic reaction in the development of eczematous skin lesions in patients with atopic dermatitis (AD) OBJECTIVE: The aim of this study was to evaluate the relationship of APT with skin prick test and specific IgE for cockroach antigen. And we attempted to find the optimal vehicle and concentration of APT for cockroach allergy in AD patient. METHODS: We performed APTs in 50 patients with AD with using German cockroach allergens (the extract with different concentrations and vehicles). The reactions were evaluated after 48 hours, and these were compared with the results of the skin prick test and the total and specific IgE levels. RESULTS: The AD patients who had cockroach allergy, according to a skin prick test or the specific IgE level, showed higher positive APT reactionsthan the non-allergic patients to cockroach. The APT reactions showed a significant relationship with the skin prick test and the specific IgE level (85.7%). With regard to the form of cockroach antigen, a positive APT was more frequent with using the powder form that with using the extract. Regarding the vehicle, petrolatum induced higher positive APT reactions than did distilled water. There was a close relationship between the antigen concentration in petrolatum base and a positive APT reaction. Ten and fifty percent cockroach antigen elicited positive APT reactions than did 1% cockroach antigen with using a petrolatum base. CONCLUSION: Petrolatum is an optimal vehicle for an APT for cockroach because an APT with a petrolatum base revealed the highest correlation with cockroach allergy. The dose-response relationship between antigen concentration and the frequencies of positive APT reactions demonstrated that 10% and 50% cockroach antigen is superior to 1% cockroach antigen.

Squamous Cell Carcinoma in situ on the Penis Successfully Treated with 5% Imiquimod Cream / 대한피부과학회지

Squamous cell carcinoma in situ on the penis has been reported to have variable success and morbidity. A 71-year-old male patient with the condition was successfully treated with a topical application of 5% imiquimod cream, three times a week for 4 weeks. A biopsy specimen was obtained to confirm tumor clearance. There was no clinical evidence of any residual tumor 3 months after the therapy was completed. There was also no evidence of scarring, deformity or systemic side effects.

A Case of Chronic Eczema Improved by a Nickel Restricted Diet in a Nickel Sensitive Patient / 대한피부과학회지

Most nickel-sensitive patients often experience aggravation of skin lesions after direct contact with nickel which is released from a variable of objects. In some patients, it is difficult to ascertain the source of exposure and alleviate symptoms, even though they avoid contact with nickel-containing objects. This suggests the possibility of an endogenous cause of nickel-induced dermatitis. Here in, we report the successful therapeutic use of a nickel-restricted diet for a nickel-sensitive patient with chronic eczema. A 39-year-old female patient was diagnosed as having endogenous nickel-induced dermatitis on the basis of personal history, physical examination and a nickel oral challenge test. Her skin lesions cleared up after follwing a nickel-restricted diet for 8 weeks.

A Case of Perforating Lichen Nitidus / 대한피부과학회지

Lichen nitidus is an uncommon, asymptomatic cutaneous eruption. There are many reports of variable subtype of lichen nitidus including of spinous, follicular, vesicular, hemorrhagic, actinic, purpuric, and perforating lichen nitidus. We report a 7-year-old boy who presented with multiple generalized papular eruption that was composed of discrete, flesh colored, 1-2mm sized, glistening, and round shaped papules. The histopathology of the biopsied specimen showed a well-circumscribed dermal infiltrate mainly composed of histiocytes. The overlying epidermis showed atrophy, thinning of granular layer and liquifaction degeneration of basal layer. Transepidermal perforation was observed and eosinophilic amorphous debris was in the channel of the perforation.

A Case of Kaposi's Sarcoma Treated with Paclitaxel / 대한피부과학회지

Kaposi's sarcoma (KS) is an angioproliferative disease of the skin and viscera, with the multifactorial origin arising in different clinic-epidemiologic forms. We report a case of a patient with generalized cutaneous and visceral KS, which was successfully treated with paclitaxel. A 78-year-old woman presented with a 2-month history of multiple purpuric nodules and plaques of Kaposi's sarcoma on the face, trunk, and lower extremities. She had not acquired an immunodeficiency syndrome or undergone organ transplantation, but had suffered with osteoarthritis and had taken unknown medication the year prior to presentation. Oral analgesics had also been used as required. Biopsies of both skin and stomach mucosal lesion confirmed KS. The patient was treated with bi-weekly doses of paclitaxel for 5 months. 6 months after the treatment course, histopathological findings on the resolving lesion showed no evidence of Kaposi's sarcoma.

A Study of Nickel Content in Korean Foods / 대한피부과학회지

BACKGROUND: Nickel-sensitive patients may suffer from persistent dermatitis even if they avoid cutaneous contact with nickel-plated items. Therefore, an endogenous cause of nickel-induced dermatitis has been suggested. In Western countries, many studies suggested that reduction of dietary intake of nickel might benefit nickel-sensitive patients. OBJECT: We measured the nickel content of Korean foods, since a nickel-restricted diet is essential for nickel-sensitive patients. METHOD: We ground the food, then nitric acid, sulphuric acid, and fluoric acid were added to the ground foods to dissolve organic matter. We then measured nickel content in these samples using Inductive Coupled Plasma-Mass Spectrometry. RESULTS: A green tea bag contained 235.57mg Ni/kg, a black tea bag 62.79mg Ni/kg, chocolate 27.87mg Ni/kg, crisps 12.70mg Ni/kg, wheat flour 12.15mg Ni/kg, Welsh onion 0.026mg Ni/kg, garlic 0.016mg Ni/kg, milk 0.004 mg Ni/kg, egg 0.002mg Ni/kg, and salt 0.0mg Ni/kg. CONCLUSION: High nickel concentrations were found in green tea bag, chocolate, crisps, wheat flour, coffee bean, peanuts, and kimchi etc. On the other hand, rice, barley and spice had low content of nickel. Formulation of nickel-restricted diet using these results is expected to be helpful in the treatment of nickel-sensitive patients.

Development and Expression of Recombinant Ara h 1 Fragment Proteins

No abstract available.

A Case of Cutaneous Infection with Mycobacterium Chelonae / 대한피부과학회지

Mycobacterium chelonae is a rapidly growing atypical mycobacteria that can cause both systemic and cutaneous infections as a human pathogen. This saprophyte is ubiquitous in the environment and has been found in water, soil, and dust particles. Clarithromycin is a highly specific drug against M. chelonae. A 53-year-old man had a nodule on the dorsum of his right hand that had developed in 3~4 months. The lesion was a slightly tender 2.0x1.5cm erythematous nodule and had an overlying ruptured pustule. Culture demonstrated atypical mycobacterim, with a polymerase chain reaction (PCR) which confirmed M. chelonae.

A Study on Anti-irritant Effect of Aloe Vera Gel Against the Irritation of Sodium Lauryl Sulfate / 대한피부과학회지

BACKGROUND: Aloe vera has been used for medical purposes since antiquity, so it has been known as the healing plant or silent healer. It has been claimed that aloe has several important therapeutic properties including promotion of wound healing, thermal injury healing, anti-inflammation and immunomodulation. Using these effects, it has become an ingredient in a wide variety of cosmetic products including night creams, soaps, shampoos, suntan lotions, and cleansers. OBJECT: In order to investigate the anti-irritant effect of aloe vera we measured transepidermal water loss (TEWL) and erythema index (E-index) after performing a patch test using sodium lauryl sulfate (SLS) and aloe vera we then compared the extent of damaging effect on the skin barriers and the difference of the recovery process in each case. METHODS: Fifteen volunteers, all over 18 years of age, who hadn't had past or present history of atopic dermatitis and other eczemas, were tested in this study. SLS was dissolved in distilled water to the concentration of 1% and aloe vera gel was dissolved in distilled water to the concentrations of 10, 20, 50, and 100%. Then we mixed 1% SLS solution and each concentration of aloe vera solution with the ratio 1: 1. Each solution was applied to marked sites of both volar aspect of the forearm at random, for 24 hours, using large Finn chamber with filter paper. TEWL and E-index were measured before test (BL) and at 30 minutes (D0), 1st day (D1), 2nd day (D2), 1st week (W1), 2nd week (W2), and 3rd week (W3) after removal of the patches. RESULTS: TEWL after removing a patch of 0.5% SLS was higher than that of 100% aloe vera mixed with 1% SLS. In addition, TEWL after removing a patch of 0.5% SLS and 100% aloe vera patch mixed with 1% SLS were higher than that of 100% aloe vera. E-index after removing a patch of 0.5% SLS was higher than that of 50% aloe vera mixed with 1% SLS, 100% aloe vera mixed with 1% SLS, and 100% aloe vera. CONCLUSION: We have come to know that aloe vera has an effect in the recovery of skin barriers and erythema induced by irritant such as SLS. However, it only happens when the gel of aloe vera has a high concentration.

A Study of Food Allergy in Patients with Urticaria / 대한피부과학회지

BACKGROUND: Although urticaria is a common skin reaction pattern occuring at some time in the life of approximately 15% to 20% of the population, the exact prevalence of food-induced acute or chronic urticaria remains unknown. OBJECT: The purpose of this study was to determine the prevalence of specific food allergies in patients with urticaria and the potential utility of the skin prick test and CAP-RAST FEIA in the diagnosis of food allergy. METHODS: One hundred patients with urticaria were evaluated for food hypersensitivity by history, eosinophil count, IgE, skin prick test, CAP-RAST FEIA, and open food challenge test (OFCT). RESULTS: 1) The prevalence of specific food allergies in the study population was 35% in history and 8, 18 and 6% in prick, CAP-RAST FEIA and OFCT, respectively. 2) The frequent food allergens were milk, egg, peanut, and wheat. 3) There were no correlations between the duration of urticaria and prick test, CAP-RAST FEIA and OFCT results. 4) Serum IgE levels were correlated with the prick test and CAP-RAST FEIA results, but not the OFCT results. 5) According to the history, 35 patients with urticaria answered that their symptoms were related to food, and of the 35 patients, positive reactions to the prick test and CAP-RAST FEIA were observed in 6 and 10 patients, respectively. Among the other 65 patients who answered that there was no relation between urticaria and food, 2 patients reacted positively to the prick test and 8 patients showed positive result to CAP-RAST FEIA. CONCLUSION: In contrast to high prevalence of food history, the prevalence of food-induced allergic urticaria in Korean patients is only 6%. In contrast to the prick test, CAP-RAST FEIA provides a standardized measurement of food specific IgE antibodies, which may be more useful diagnostic test than prick test to diagnose food allergy in urticaria.

Phototherapy of Acne Vulgaris with Low Level Narrow Band Red Light (680 nm) / 대한피부과학회지

BACKGROUND: It has been reported that the phototherapy with blue light (415 nm) or a mixed blue and red light (415 nm and 660 nm) is effective in the treatment of acne vulgaris. however, the effects of red light on acne vulgaris have not been investigated. OBJECT: To examine the effects of red light (680 nm) on patients with moderate acne vulgaris. METHODS: Patients treated their skin by themselves, using portable light source (680 nm), and irradiation was performed for 7 minute twice daily. Each patient was evaluated every 2 weeks with Burton scale and the numbers of papules and pustules. After 6 weeks, the degrees of satisfaction of patients and physicians were assessed. RESULT: Therapy with red light significantly decreased the numbers of papules and pustules (p<0.01). The numbers of satisfied patients and physicians at the end of treatment were 59 (83.1%) and 56 (78.9%) respectively. Side effect was not reported, except only one patient complained of headache. CONCLUSION: Phototherapy with red light (680 nm) was effective and safe treatment for patients with acne vulgaris.

A Case of Allergic Contact Dermatitis Due to Topical Minoxidil / 대한피부과학회지

Minoxidil (2, 6-diamino-4-piperidinopyrimidine 1-oxide) is a systemic antihypertensive agent, the topical application of which has been shown to produce hair growth. Topical minoxidil solution (5% minoxidil, propylene glycol, alcohol, water) has generally been well-tolerated, but allergic contact dermatitis has been reported. When allergic contact dermatitis to minoxidil solution is suspected, evaluation of ingredients of minoxidil solution should be performed because allergic contact dermatitis due to propylene glycol in minoxidil solution has been frequently reported. A 34-year-old male presents with a diffuse erythematous patch on the scalp. He has applied minoxidil solution for 7 days due to androgenic alopecia. A Patch test with Korean standard series and the ingredients of used topical agents showed positive reactions to 1%, 2% and 5% minoxidil solution.

A Case of Atopic Dermatitis due to Peanut Allergy / 대한피부과학회지

Peanut allergy is common and potentially severe. This hypersensitivity reaction starts early in childhood and continues throughout life. Dietary elimination of peanuts is mandatory when atopic dermatitis is accompanied with peanut allergy. We experienced a case of a 9-year-old female atopic dermatitis patient showing positive CAP RAST and oral food challenge test with peanuts. Her skin lesions were cleared after dietary elimination of peanuts.